Dr Shaw: Open all hours?

What do you do when your kid is ill? We all have different approaches, some of us are lenient, some of us are strict. Me? I'm strict, I can see through the 'I have a tummy ache' and 'I don't feel well' and have no doubt that as he gets older his fake illnesses to avoid school will be common place. On the occasions where he is sick I used to do what everyone does! Freak out! What if it's something really bad?! I would give Calpol and cuddles, it cures most things after all! Failing that, i'd call NHS direct or call the GP and make an appointment. One thing I didn't do this......

"35 year old female, her daughter doesn't feel well"

I recently moved house. After a prolonged absence I came back to my home town. It was a stressful yet exciting time. I moved in on a Friday and was unpacking solidly until work on Sunday afternoon. I finished this particular shift at 3am. I crawled into my bed, knowing that there was no need to set an alarm. I had 4 days off so catching up on sleep was top of my priority list! Therefore, you can imagine my displeasure at being woken at 7:30 by a ring on my doorbell. Who in god's name is that? The postman? I don't care, it can't be that important. Apparently it was, the bell rang again. Begrudgingly I got up, chucked some clothes on and staggered down stairs. Looking like a wild banshee I opened the door. A 35 ish year old woman was standing there, well dressed, well kept, with a 6-7 year old girl standing by her side looking miserable. That makes two of us.....

"Hello there, my name is Joanne, I live a few doors up"

Failing to see her point I croaked a vaguely audible hello back, making my displeasure at being woken perfectly clear with the cunning use facial disgust and body language!

"I saw you leave for work yesterday and couldn't help but notice you were a paramedic"

I knew where this conversation was heading. Things started to make sense now, she was being strangely friendly because she wanted something and the child was looking suitably unhappy to suggest she wasn't well. Begrudgingly I replied 'yes, I am' in a tone that conveyed annoyance, displeasure, frustration and anger all at the same time.

"I was wondering if you could help me, Chloe here isn't feeling well, she is really hot and flushed as you can see and says her throat is very sore. She has hardly slept all night and has a terrible cough. I didn't want to go through the palaver of dragging her up to the GP, you know how it is. Would you be able to check her over?"

Firstly, I had to check over my shoulder to see if there was anyone behind me who gave a crap. Nope, no one there, she is actually talking to me. Secondly, I had to decide how to play this one. Do I......

a) assess the child like the consummate professional and provide the necessary health advise to appease this anxious mother.

b) rant, tell her exactly what I'm currently thinking, tell her what I'd really like to do with people like her.

c) stare blankly for 3 seconds, turn slowly and slam the door as i staggered back up the stairs.

Well, A was never going to happen, I was too annoyed and too tired. B, tempting, do I risk upsetting a neighbour after 2 days and C, again, bit risky. After a brief moment of consideration, I went with B. A rant. 

"I don't mean to be rude, but I didn't get home until gone 3am. This is my rest day and now I'm up. I'm not a GP, I can't prescribe medication, I can't even take her temperature. I'm not telling you how to suck eggs but surely, if a kid is hot and coughing, they have a cold. Calpol will probably do the trick but what you expect me to be able to do I don't know. And, to be perfectly honest I think it's a bit off for you to come here, first thing in the morning based on seeing me leave in my uniform yesterday. If you are worried take her to the GP."

"Sorry, I should have thought, I'll let you get back to sleep, sorry"

Admittedly, I got a card through the door to apologise again which I appreciated but still! What a bloody cheek! The audacity, to knock on my door because she couldn't be arsed to go to the GP.  Is she for real? And, someone she has never met before! I was speechless! It doesn't say 'Dr Shaw: Open all hours' above my door. In fact, if I did have a sign above my door it would say 'Jog on!' I get it, people worry about their kids, but a kid with a cold? She is 6 years old. That means she has had 6 years at managing and treating a cold! Surely, knocking on a strangers door isn't top of her list of things to do? How dare she?! Needless to say, I vented, ranted, stomped and shouted for the rest of the morning.  

I'm not a miserable git, honest, and if someone was in need I'd always be there and have been. I've helped out with cardiac arrests and RTC's when off duty but interrupting my sleep for a cold is not, and will not, ever be acceptable. Ever. 

Ever.

Fat people, stairs and backs.......(the follow up)

Following the posting of my last blog it appears I offended some people. Let me make this very clear. I don't care, however, in the interest of rousing debate and gathering public opinion i'm going to make the conversation I had public. These are my opinions and mine alone. Some people will agree with me and some will disagree. Everyone is entitled to an opinion. Oh, and her name wasn't really Carol!

Carol: "How dare you chastise people who are suffering. Your job is to help people and berating them is nothing short of negligent"

Me: "They are my opinions, I base them solely on experience and fact. You clearly have an agenda for your dislike of my posting"

Carol: "Its not an agenda, I am obese and also the full time carer for my husband. He is 42 stone and isn't able to work. He is ill and to think that if he needs an ambulance someone as biased and bigoted as you may show up is horrible. You are a fucking disgrace to your profession. Fat hater"

Me: "My opinions have NEVER compromised my patient care, nor my treatment to a patient. I didn't say morbidly obese patients didn't deserve care, I merely said throwing money at bigger equipment is not the answer. If you dragged yourself away from the donuts and read my blog properly you would understand that. Also, if you want to berate me, have the balls to do it publicly where I can defend your baseless accusations"

Carol: "Fuck off"

Me: "Good response"

Carol: "Yeah it was, I don't like the way his illness is singled out"

This whole blog is a pot calling the kettle black
moment so while i'm on a roll !!

Me: "Again, read read read. I quote my blog 'I know that morbid obesity is an illness, like alcoholism, but they are both avoidable & they are both lifestyle choices'. I havnt singled morbid obesity out, i've said it his an illness through lifestyle choice. That is fact"

Carol: "You are despicable. You are going to hell"

Me: "I don't care what you think, not one iota. If you'd voiced your opinion i'd engage in discussion with you but abuse is not welcome. Whine to someone who gives a damn"

Carol: "Fuck you"

(blocked)

Ok, the donut comment was a cheap shot but I don't write my blog to appease the masses or make friends. It's my way of venting frustrations, voicing opinions and sharing funny experiences. I try to educate and amuse in my own little way. I don't go out of my way to offend but if i do, I won't make any apologies for it. 99% of people who have read my blog take it how it is meant. I'm not a nasty person and am sympathetic to anyone who is ill. That is why I do this job. That doesn't mean I can't moan and suggest ways to right the wrongs in society. Sticking my head in the sand and saying everything is ok is naive to say the least. Thank you to everyone who has agreed and disagreed. I'm always open to discussion, just not an onslaught of abuse. Over and out! 

Fat people, stairs and backs

The EMS Theory of Weight: The weight of a patient that you are about to transport increases by the square of the sum of the number of floors which must be ascended to reach the patient plus the number of the floors which must be descended while carrying the patient.

• Corollary 1: Very heavy patients tend to gravitate towards locations which are furthest from sea level
• Corollary 2: If the patient is heavy, the elevator will be broken, and the lights in the stairwell are out
• Corollary 3: The further the distance from sea level, the iller the patient will be

"48 year old female, keeps fainting, patient is obese, weighs 35 stone"


On receiving this job, and physically hearing our backs scream 'Nooooooooo!'three things were going to be absolutely certain about what was going to happen.

1. This was going to take ages
2. This was going to hurt
3. She was without doubt, going to be upstairs

As predicted the patient was upstairs, and not just upstairs, up 4 flights of stairs. The corridors in her flat were winding and narrow so extrication as predicted would take ages.  I've never seen someone so large in person. Ive seen people on the usual TV programmes but this was absurd. How can anyone let themselves get like this? She was pale and sweating, and looked ill. She was indeed fainting, every time she sat up in fact. Her list of ailments was as long as my arm and exactly what you'd come to expect from someone that size. Heart failure, diabetes, hypertension, high cholesterol, bed sores, the list goes on and on. It transpired that she hadn't left her bedroom for 4 years. Well, that was about to change!

After giving her the full MOT including ECG (I will be scarred for life) it was clear she had to go to hospital. The problem being was how? She was too big and heavy for our chair (and impossible to lift) and was too heavy for our trolley bed. She also a) couldn't walk and b) fainted when she sat up. We contacted control and arranged for the bariatric ambulance to be dispatched. The bariatric ambulance has special chairs and beds for such situations but cost a lot of money. For the ambulance alone it's about £100,000, special cushions cost about £2,500, stretchers are between £7,000 to £10,000 while reinforcing vehicle tail-lift costs about £800 per time. Heavy duty wheelchairs cost at least £400 and hoists are £4,500 a time, however, all of this was useless as she needed to be kept flat, so there was only one thing for it. The fire brigade and a crane!

This is obviously not our patient!!! That would break the rules!!

In all their glory the fire brigade arrived, kitted up, erected cranes and ladders, removed the double glazed windows and then assisted us to get the patient into a bariatric scoop. Inevitably, by the time she was craned out the window a rather large crowd had gathered. Obviously, I was thriving on this but it was mortifying for the patient. With strict instructions as to how I wanted her removed she was craned down to us, and onto the aforementioned £10,000 bed. To cut a long story short, we got her to hospital, my back still in one piece and the patient still alive, but at what cost? We had been on scene for over 5 hours, as had the FRU. We had the bariatric ambulance and the fire brigade as well of the cost to put her windows back. I'd imagine the fact that she was in a 2nd floor council block and hadn't left the house for so long meant she was on all the benefits available to her. The only cost to her today was her dignity and health. 

At what point did society allow gluttony to become a disability? I am NOT talking about those among us, me included who are overweight or even obese. Those who live to excess, enjoy the nicer things in life and don't care. You can do all that and still be relatively health. You don't need a crane though. When your size means you cannot work THAT is to much. At what point will something be done to stop this growing trend? Do we just throw specialist equipment at the problem? Whatever next? Call in the Army with a Chinook helicopter to replace the inadequate air ambulances? The only way people will learn is in their pockets, if the NHS doesn't fund obesity treatments and stops offering gastric band surgery like paracetomol maybe there will be an incentive to self-help. There is also a financial cost in sick leave to staff. Every single day, ambulance staff go off on long term sick due to back injuries from lifting obese people up and down stairs. This isn't an assault on the overweight. Far from it. People can function being overweight, they can do most jobs and can be self sufficient but it becomes a problem when the ability to do every day functions is compromised. When someone becomes reliant on others due to greed and excess that is where the line has to be drawn. Being classed as disabled, not being able to work, walk, shop or wash because of indulgence is not acceptable, nor is relying on ambulance staff to carry you up and down the stairs.

I'm sure some people will be offended by this stance but quite frankly, I don't care. I know that morbid obesity is an illness, like alcoholism, but they are both avoidable & they are both lifestyle choices. People are born with all sorts of incurable diseases, cancer can grip anyone at anytime but no one is born morbidly obese. It's nature vs nurture where nurture has won. There may well be social and psychological reasons behind peoples obesity and I look at that in 'Obesity: The cause, the cost, the solution'. but that doesn't exempt them from blame or responsibility. I'm not suggesting they don't deserve the same high standard of treatment everyone else gets, I'm saying we must find a prevention rather than a cure. 

A Feline Frenzy

"Sick cat, feeling suicidal, wants to kill herself, caller states she is hitting and trying to hurt / kill the cat"

Where do I start? Obviously, there is an issue as to who the patient is? Is the call taker talking to a cat? If so the the call taker needs to be seen.  Is the cat sick? Is the cat suicidal? If so, how is the cat intending to kill herself? If the cat didn't call then why is the caller trying to hurt / kill the cat who is clearly already sick and suicidal? Or, is this an assisted suicide case? Is the caller trying to help the cat end it's suffering? Or, is the caller suicidal because her cat is sick? But if the cat being sick has made her suicidal then why is she hitting the cat? Are we going to walk into a feline bloodbath? Will the cat have taken an overdose? Will cat and caller both be dead on a bed resembling a scene from Romeo and Juliet? There are so many questions and we haven't even arrived yet.

When we did arrive, full of uncertainty and intrigue, we were met at the door by the caller, not the cat. She was a large lady, with hair resembling 'Doc' Brown from Back to the Future! She was panting and sweaty. It transpires that she is suicidal because she can't catch the cat. The cat was under the bed, hiding from woman who appears to be suffering 'general mentalness'. The cat was sick, the cat isn't sick, but was just sick. On the kitchen floor to be precise. The caller has since been trying to catch the cat, to hurt / kill it for being sick. As she has been unable to catch the cat she is now feeling suicidal. This cat has caused a lot of problems.

So, what do we do? The patient won't be reasoned with. As far as she is concerned the cat needs to die. She doesn't think she is being irrational, in fact she doesn't understand why we won't assist in the 'kitty carnage' she has planned. This my friends, is mental health at its very best. We can't leave her, the cat will die. We can't take her, she has capacity. So all we have left was a sectioning. She has said she intends to kill herself if she can't kill the cat. We have a duty of care to her. And maybe the cat too. I'm not sure on that. Jokes aside, when talking about anything other than the cat, she was rational. In fact, she seemed normal, say the word cat however and all hell broke loose. Images of Tom and Jerry repeatedly sprung to mind. After much faffing and many wasted hours the police eventually managed to convince her to come voluntarily. I'm sure the cat smirked as she was led out of the house. How bizarre!

No excuse

"Emergency Service workers assaulted - Again"

As I grew up, I was led to believe that the emergency services were good people. The police caught the robbers, the firemen dragged people from burning buildings and paramedics helped people who were hurt. The thought of attacking these good people was not a notion that had ever crossed my mind. It wasn't until I was old enough to read or be interested in reading the news that I began to hear of the violence and abuse which emergency services have to deal with on a daily basis. 

Obviously, wrong as it is, the police expect it and are used to it, and therefore are trained to deal with it. Battons, CS gas and Taser guns are but a few of the things at their disposal. The firemen, who do not have such tools nor the training do however have strength in numbers. They generally respond 2-3 engines at a time and lets be honest, 18 fireman isn't an easy target for abuse. We however, travel in pairs at best, often solo in a car with only a 1/2 day course in conflict resolution.

Verbal abuse is a daily occurrence as are threats of violence, but more worryingly acts of violence are becoming common place. In the past year or so, only a handful of high profile incidents are reported on the news, most notably the crew who got shot at. This however is not an isolated incident. I personally have had a knife pulled on me, been punched and kicked, spat at, had bottles thrown at the ambulance and that's just in the last year. I've had friends chased with poles, pushed down stairs, surrounded by youths, had threats to their lives and driven at. These don't make the news, they simply become mess room moans.

We are an ambulance service, we work horrible shifts, long hours, night and day, rain and shine to help people. We shouldn't have to go to work with fear of assault or abuse. The fact that stab vests are standard issue speaks volumes of the state of this country, but what is going to be done about it? The signs in the trucks say how anyone who abuses the staff will be prosecuted blah blah blah but in reality nobody is. Nothing happens. The CPS never have enough to prosecute and the police rarely take it further than diffusing the situation. What will it take for something to be done to solve this problem? Crews to be crippled or killed? Will there be public outcry then? Every one knows the problem exists but no one is willing to make a zero tolerance stand against it and until they do, going to work with the fear of getting sworn at, spat at, punched or kicked will be the norm.